| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,178 |
1,876 |
$267K |
| D0330 |
Panoramic radiographic image |
3,818 |
3,701 |
$194K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,463 |
732 |
$156K |
| D0210 |
Intraoral - complete series of radiographic images |
2,436 |
2,182 |
$150K |
| D0140 |
Limited oral evaluation - problem focused |
5,973 |
5,560 |
$150K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,580 |
970 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,814 |
3,686 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,864 |
964 |
$111K |
| D1110 |
Prophylaxis - adult |
2,419 |
2,355 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,494 |
335 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,292 |
2,243 |
$48K |
| D2335 |
|
337 |
182 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,748 |
1,695 |
$39K |
| D9243 |
|
670 |
177 |
$31K |
| D1120 |
Prophylaxis - child |
1,196 |
1,163 |
$30K |
| D9239 |
|
430 |
401 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,506 |
1,469 |
$29K |
| D2331 |
|
241 |
139 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,472 |
1,103 |
$19K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
278 |
73 |
$17K |
| D2394 |
|
205 |
132 |
$16K |
| D9610 |
|
235 |
207 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,549 |
2,323 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
72 |
24 |
$13K |
| D9222 |
|
90 |
85 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
25 |
$10K |
| D0250 |
|
749 |
721 |
$10K |
| D2332 |
|
121 |
70 |
$10K |
| D2330 |
|
134 |
76 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
69 |
39 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
215 |
212 |
$3K |
| D7230 |
|
21 |
12 |
$3K |
| D9612 |
|
61 |
61 |
$3K |
| D0272 |
Bitewings - two radiographic images |
195 |
186 |
$2K |
| D7250 |
|
21 |
12 |
$1K |